Pathology of cancer Flashcards

1
Q

Histopathological assessment important for

A
  • Diagnosis - tissue confirmation is needed to know whether to diagnose cancer or not
  • tissue for subtyping the cancer
    • need to understand terms used in pathology reports- Prognosis e.g. Tumour grading and staging
  • Treatment e.g. Surgical resection, chemotherapy, radiotherapy
  • Additional ancillary tests e.g. Molecular testing for prediction of chemo/immunotherapy
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2
Q

What is meant by neoplasm

A

is a mass of cells

Neoplasm literally means “new growth”

  • they have undergone an irreversible change from normlaity
  • proliferate without any signal to stop them
  • they are partially and completely independent of factors that control normal cell growth
    • doesn’t have signals to tell it to stop, so it grows and multiples
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3
Q

Definition of cancer

A

A malignant neoplasm

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4
Q

How do we classify neoplasm

A
  • behaviour
    • is it benign or malignant
  • histogenesis
    • where it came from
  • histological cells
    • subtyping within tissue
      • squamous → carcinomas, glanduar → adenocarcinomas
      • within different tissues, you can have different types of cancers
        • this is important because they all have differently
  • functional: hormone secretion
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5
Q

Classification of neoplasm

How can maligant neoplasms behave

like what can they do

A
  1. Local invasion into surrounding tissue
  2. Spread to distant sites to form secondary deposits (metastases).
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6
Q

Classification of neoplasm

How can neoplasms metastise

A

Metastasis occurs via two main routes (lymphatic and haematogenous via venous channels )

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7
Q

Classification of neoplasm

What is meant by the phrase neoplasms can behave in an intermediate way

A

invades local tissues but does not metastise

e.g basal cell carcinoma of the skin

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8
Q

Classification of neoplasm

Epithelial

what do we call them, where do they line, are thet malignant

A

name: carcinoma
tissues: skin, lung, gastrointestinal tract
maliganancy: most epithelial tissues are malignant

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9
Q

Classification of neoplasm

Mesenchymal tissues

what do we call them, where do they line, are thet malignant

A

name: - if bengin tumor from soft soft tissue “lipoma”, muscle “leiomyoma”, blood vessels “ haemangioma”
- If malignant termed “ sarcoma”

tissues: bone, cartilage, bone marrow stroma, interstitial fibrous tissue, skeletal muscle,

maliganancy: typically benign neoplasms but if malignant called sarcoma

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10
Q

Classification of neoplasm

What are Haemato-lymphoid neoplasms called

A

lymphoma

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11
Q

Classification of neoplasm

If a cancer is involves blood cells, what is it called?

A

leukaemia

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12
Q

Classification of neoplasm

What are germ cell neoplams called

A

teratoma, seminoma

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13
Q

Classification of neoplasm

What is meant by ifferentiation

A
  • the degree to which neoplasm resembles its tissue or origin
  • begin
    • well-differentiated looks similar to the parent cell
  • malignant
    • differentiation is variable
      • can look like parent cell or look nothing like it
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14
Q

How do we grade differenation

A

Grades 1-3
well differeniated to poorly

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15
Q

Why is knowing tumor differeniation important

A
  • Poorly differentiated cancers behave more aggressively
  • Well-differentiated cancers have better prognoses and certain well-differentiated cancer
    • for example, prostate can be managed conservatively
  • Some malignant tumours are so poorly differentiated hard to determine their histogenesis
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16
Q

if its hard to determine what cell the cancer came from what is it called

A

called ANAPLASTIC.

17
Q

What is a begnign cancer from glandular tissue called

A

adenocarcionma

18
Q

Classofication

Tertorma

where do they come from

A
  • comes from embryonic germ cells
    • comes from all three germ cell layers
      • ectoderm
      • mesoderm
      • endoderm
19
Q

Where do Teratomas occur

A
  • Ovary - usually benign
  • Testis - usually malignant
  • Midline structures - behaviour variable (retroperitoneum, mediastinum)

can find hair, teeth, repsortory lining, skeletal muscle, skin

20
Q

Compare gross apperance of neoplasms

begnin bold, maligant normal

A

Shape: well circumsised/irregular
size: generally smaller can be MASSIVE/generally larger
haemmorhage: unusual/common
ulceration: unusual/common
necrosis: unusual/common

21
Q

Difference in begnin and malignant nuclei

A

benign: normal
maliganant: massive

nuceloi more promianat in maligant

maligant cells vary in size loss of polarity,

22
Q

Difference in growth of B and M

A

Speed: Slow/rapid
spontenous arrest: common/rare

23
Q

Types of bioposes

A
  • endoscopic biopsies (e.g. upper & lower GI tract, bronchus)
  • needle biopsies (radiologically guided)
  • punch biopsies (skin)
24
Q

How can we get cytology specimens

A
  • smears (e.g. cervical)
  • endoscopic brushings
  • body fluids (e.g. sputum, urine, effusion fluids)
  • fine needle aspiration specimens

cytology is quick and cheap to obtain diagnosis

25
Q

Limiations of bioposy

A
  • tumour heterogeneity
    • may not be repsenstive of the whole tumor
  • targeting lesions may be hard because they are
    • small lesions
    • inaccessible
    • surrounding stromal reaction
26
Q

Why is cytology good

A
  • ess invasive
    • bladder cancer→ urine
  • fine needle
    • stick into mass
    • and then sent to pathology
  • smaller tissue samples provided
    • cells, instead of groups
      • problem: may be hard to interpret compared to a biopsy
27
Q

Why do we do bioposies or cytology

A

– Confirm the diagnosis of malignancy

– Determine the aggressiveness of a tumour (histological grade)

– Assess the extent of spread (histological stage)

– Examine completeness of excision.

28
Q

What do we need to look at macroscopically

about tumor

A
  • Size
  • Shape (well-circumscribed or irregular).
  • Extent of local spread.
  • Proximity to surgical resection margins.
  • Identification of lymph nodes (important for staging).
  • Other macroscopic features where relevant (e.g. colour, haemorrhage, necrosis).
29
Q

What do we know about tumor microscopically

A
  • Confirms ( or establishes) a diagnosis of cancer.
  • Other features that are assessed microscopically include the following:
    • Histological type (e.g. glandular, squamous).
    • Degree of differentiation (histological grade).
    • Frequency of mitoses.
    • Local invasion.
      • Presence is important in determining a diagnosis of malignancy (e.g. capsular invasion in follicular carcinoma of the thyroid gland or hepatocellular carcinoma).
      • Extent is important in staging.
  • Vascular invasion.
  • Examination of lymph nodes (for metastases).

This decides treatment after surgery

30
Q

What is immunohistochemistry

how does it work, and use

A

What?
method of detecting the presence of specific proteins in cells or tissues.

How?
An antibody for each antigen. (epithelial - cytokeratin, lymphoid

Use?
Can help subtype and diagnose

  • can also help for prognostic markers
    • like markers of cell turnover

can be used for therapeutic options

  • specific antigen markers used to idnentuy tumors that are likely to be good with the specific therapies tareggting that specific antibody
    • e.g breast carcinomas expressing the growth factor HER2 can be treated with Herceptin.
31
Q

What is molecular pathology

use + role

A
  • gene mutation analysis; FISH; detection of specific translocations
  • to support the diagnosis
  • to predict response to targeted drugs (KIT in GIST; EGFR2 in breast adenocarcinoma; RAS in colorectal adenocarcinomas

Role of molecular biology

  • diagnostic
    • can diganose based on what translation or found etc
  • progonsitic
    • gilmoas with certain numbers like 1p, 19q LOH have a better prognosis
  • predictive